Provider Demographics
NPI:1154792000
Name:EAST CAROLINA REHAB AND WELLNESS, LLC
Entity type:Organization
Organization Name:EAST CAROLINA REHAB AND WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:HUGH
Authorized Official - Middle Name:B
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:910-332-4508
Mailing Address - Street 1:201 N FRONT ST
Mailing Address - Street 2:STE 805
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-4055
Mailing Address - Country:US
Mailing Address - Phone:910-332-4508
Mailing Address - Fax:910-332-4508
Practice Address - Street 1:2575 W 5TH ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-7813
Practice Address - Country:US
Practice Address - Phone:252-830-9100
Practice Address - Fax:252-757-3219
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-16
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNH0505314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCNH0505OtherLICENSE
NCNH0505OtherLICENSE